Healthcare Provider Details

I. General information

NPI: 1770541872
Provider Name (Legal Business Name): KATHY LAURIE HATA OTR/L, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY LAURIE HATA-THOMPSON OTR/L

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 SOUTH 12TH AVENUE SUITE 5
YAKIMA WA
98902
US

IV. Provider business mailing address

PO BOX 9246
YAKIMA WA
98909-0246
US

V. Phone/Fax

Practice location:
  • Phone: 509-469-4996
  • Fax: 509-469-4922
Mailing address:
  • Phone: 509-469-4996
  • Fax: 509-469-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60016860
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00000673
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: